Poster Session I - A118 TREATMENT OF IDIOPATHIC DIABETIC DIARRHEA: A SYSTEMATIC REVIEW

TL;DR

This systematic review evaluates treatments for idiopathic diabetic diarrhea, finding that somatostatin analogues show the highest symptom improvement.

Contribution

The study systematically reviews and summarizes treatment outcomes for idiopathic diabetic diarrhea using case reports and case series.

Findings

Somatostatin analogues showed 92.3% symptom improvement in idiopathic diabetic diarrhea.

Opiate antidiarrheal agents had low success rates despite frequent prescription.

Few randomized controlled trials exist, limiting definitive conclusions on treatment efficacy.

Abstract

Idiopathic diabetic diarrhea (IDD) is a complication of diabetes mellitus, marked by chronic loose or watery bowel movements without an identifiable cause. IDD remains poorly understood in the literature, with limited evidence on effective management.

To assess the scope of current literature on available treatments for IDD.

We conducted a systematic review across 4 databases, following PRISMA guidelines. Cases with known pathology, non-primary, non-human, or inadequate treatment data were excluded. Descriptive statistics were performed after data extractions outlining study designs, patient traits, methods of diabetes management, treatments, and symptomatic outcomes. Absence of randomized controlled trials and heterogeneous outcome measures made meta-analysis unfeasible.

21 studies (16 case reports, 5 case series) from 1960-2013 met the inclusion criteria (Table 1). Somatostatin analogues demonstrated the highest improvement in symptoms (92.3%; 12/13). Despite smaller sample sizes, 5-HT3 antagonists (75.0%, 3/4), corticosteroids/immunomodulators (66.7%, 2/3), and alpha-2 adrenergic agonists also showed response. Opiate antidiarrheal agents were most frequently prescribed, but only 22.9% (8/35) experienced improvement. Anticholinergics/antispasmodics (40.0%, 2/5), bile acid sequestrants (33.3%, 3/9), dietary interventions (23.8%, 5/21), and antibiotics (21.7%, 5/23) yielded variable or modest responses. Other therapies without symptomatic response included prokinetic agents, pancreatic enzyme therapy, and NSAIDs.

Among available cases, symptoms most often improved with somatostatin analogues. 5-HT3 antagonists, corticosteroids, and alpha-2 adrenergic agonists were less common but showed similar rates. Opiate antidiarrheal agents, antibiotics, and nutritional interventions were frequently prescribed despite low rates of success. The availability of certain treatments may have been influenced by year and country of origin. As literature was limited to case reports and case series, larger studies and more recent data are necessary for better identification and formal comparison of treatment.

Summary of Findings on Treatments of Idiopathic Diabetic Diarrhea

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